Efficacy and safety of abatacept for systemic juvenile idiopathic arthritis: a systematic review

Kenichi Nishimura; Takashi Ishikawa; Nami Okamoto; Keiji Akamine; Natsumi Inoue; Hitoshi Irabu; Kentaro Kato; Hiroshi Keino; Masayo Kojima; Hiroshi Kubo; Kazuichi Maruyama; Mao Mizuta; Kosuke Shabana; Masaki Shimizu; Yuko Sugita; Yukiko Takakuwa; Satoshi Takanashi; Hiroshi Takase; Hiroaki Umebayashi; Natsuka Umezawa; Shingo Yamanishi; Kazuko Yamazaki; Masato Yashiro; Takahiro Yasumi; Masaaki Mori

doi:10.1093/mr/roae046

Efficacy and safety of abatacept for systemic juvenile idiopathic arthritis: a systematic review

Mod Rheumatol. 2024 May 16:roae046. doi: 10.1093/mr/roae046. Online ahead of print.

Authors

Kenichi Nishimura¹, Takashi Ishikawa^{2

3}, Nami Okamoto⁴, Keiji Akamine⁵, Natsumi Inoue⁶, Hitoshi Irabu⁷, Kentaro Kato⁸, Hiroshi Keino⁹, Masayo Kojima¹⁰, Hiroshi Kubo¹¹, Kazuichi Maruyama¹², Mao Mizuta¹³, Kosuke Shabana⁴, Masaki Shimizu⁷, Yuko Sugita⁴, Yukiko Takakuwa¹⁴, Satoshi Takanashi¹⁵, Hiroshi Takase¹⁶, Hiroaki Umebayashi¹⁷, Natsuka Umezawa¹⁸, Shingo Yamanishi¹⁹, Kazuko Yamazaki¹⁴, Masato Yashiro²⁰, Takahiro Yasumi⁸, Masaaki Mori²¹

Affiliations

¹ Department of Pediatrics, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
² Division of Immunology, National Center for Child Health and Development, Tokyo, Japan.
³ Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan.
⁴ Department of Pediatrics, Osaka Medical and Pharmaceutical University, Osaka, Japan.
⁵ Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
⁶ Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Ishikawa, Japan.
⁷ Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
⁸ Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.
⁹ Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan.
¹⁰ Nagoya City University, Aichi, Japan.
¹¹ Department of Pediatrics, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan.
¹² Department of Vision Informatics, Graduate School of Medicine, Osaka University, Osaka, Japan.
¹³ Department of Pediatric Rheumatology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan.
¹⁴ Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan.
¹⁵ Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
¹⁶ Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
¹⁷ Department of Rheumatism, Infectious Disease, Miyagi Children's Hospital, Miyagi, Japan.
¹⁸ Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
¹⁹ Department of Pediatrics, Tokyo Yamate Medical Center, Tokyo, Japan.
²⁰ Department of Pediatrics, Okayama University Hospital, Okayama, Japan.
²¹ Lifetime Clinical Immunology, Tokyo Medical and Dental University, Tokyo, Japan.

PMID: 38753302
DOI: 10.1093/mr/roae046

Abstract

Objectives: This systematic review assessed the efficacy and safety of abatacept in patients with systemic juvenile idiopathic arthritis (JIA).

Methods: Studies published between 2000 and 2021 were searched using PubMed, Embase, Cochrane, Ichushi-Web and clinical trial registries. The risk of bias was assessed according to the manual for development clinical practice guidelines by Minds, a project to promote evidence-based medicine in Japan.

Results: Seven observational studies were included. American College of Rheumatology pediatric 30/50/70 responses at 3, 6 and 12 months were 64.8%/50.3%/27.9%, 85.7%/71.4%/42.9% and 80.0%/50.0%/40.0%, respectively. Outcomes on systemic symptoms, joint symptoms and activities of daily living were not obtained. No macrophage activation syndrome or infusion reaction occurred. Serious infection occurred in 2.6% of cases.

Conclusions: Abatacept improved the disease activity index. In addition, abatacept was as safe as interleukin-6 (IL -6) and IL-1 inhibitors. However, both the efficacy and safety data in this systematic review should be reviewed with caution because their quality of evidence is low or very low. Further studies are needed to confirm the efficacy and safety of abatacept for systemic JIA, especially its efficacy on joint symptoms.

Keywords: biologic disease-modifying antirheumatic drugs; disease activity index; infusion reaction; macrophage activation syndrome; serious infection.

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